What is a bunion?
What is a bunion?
Bunions are a relatively common foot deformity with prevalence of about 44% in adult women and 22% in adult men. It is an issue of the first metatarsophalangeal (MTP) joint best described when the first metatarsal bone turns outward and the big toe turns towards the other toes. Its severity is measured by the angle the big toe makes with the first metatarsal. This angle is considered severe if greater than 25 degrees. This can often be accompanied by hammertoes or a cross over deformity of the second toe where the second toe actually crosses on top of and over the first toe. These are compensations that are often seen as the bunion has progressed or worsened. Bunions are also quite often, but not always associated with pain at that MTP joint. The skin around the joint can become red if shoes have been rubbing on that location and the joint can feel painful and stiff.
The two most common predispositions include familial history and shoe wear. Over time, wearing shoes that are tight and narrow can increase stress on the MTP joint and lead to the toe migration discussed above. High heeled shoes bring an individuals body weight forward onto the forefoot and may partly explain the greater prevalence in women. Other factors include foot type or shape (i.e. flat feet/arches) and other foot deformities that lead to increased stress on the MTP joint.
The pain associated with this joint can become very problematic. It can lead to other gait compensations and injuries at other body parts. Together, this will often lead to decreased participation in exercise activity. It stresses the importance of addressing these issues and addressing these issues early. While surgery can be performed to correct the structural issues, it is reported that about 15% of bunions reoccur even after corrective surgery. Thus, conservative management is imperative. This includes wearing proper shoe wear, activity/behavioral modification, and physical therapy.
How can physical therapy help?
As described, the joint where the bunion is located is put under a lot of stress with daily activities. This can be due to specific weakness and/or tightness in other areas of the foot and lower extremity. Your physical therapist can identify these impairments that are likely contributing to bunion formation. This can include MTP joint restrictions, weakness of the calf and toe flexor muscles, decreased ankle joint range of motion, and even issues with the two tiny sesamoid bones underneath the big toe. These impairments can greatly alter the mechanics of the foot with walking, running, and other weight bearing activities. Successfully addressing these issues can minimize the strain on the big toe and prevent further bunion formation. Bunions can be managed if addressed early and consistently. Give us a call today to start that process!
Bunion observed on X-ray with subluxation of the sesamoid bones